Research and advancement increase the capability of medicine to provide complex care. Technology can keep patients alive in states that they might not desire. Today, clinicians are responsible for (1) anticipating future care needs and (2) guiding treatments as patients become more ill and less functional. An essential tool in the clinician armamentarium, advance care planning is a skill set that must be honed to ensure that patients receive care both consistent with their informed preferences and appropriate to their prognosis. Advance care planning includes serial discussion with patients about clinical circumstances and prognosis, incorporates specific tools, requires coordination among the team of clinicians caring for a patient across venues of care, and may be facilitated by advance care planning structures. Sometimes the process also requires setting limits and addressing maladaptive coping. Building strong relationships with patients and families, and a consistent focus on goals of care is key to high quality treatment for the complex patient and achieving optimal end of life care.

When is a nosebleed not a normal nosebleed? How much menstrual bleeding is too much? Hemophilia is the best-known bleeding disorder and perhaps the most severe, but there are other milder diseases like von Willebrand disease that are much more common. What are the common myths and perceptions about children with disorders of coagulation? What does the general pediatrician need to know about bleeding disorders? The speaker will cover the basics of identifying children with abnormal bleeding and managing their conditions effectively.

Vaginitis is one of the most common gynecologic problems seen in ambulatory practice. Join us in discussing the differential diagnosis, which includes not only a vaginal infection, but also cervicitis, a physiologic discharge, atrophic vaginitis, and iatrogenic vaginitis. A precise diagnosis can be achieved with a careful history, focused examination, and skilled use of the office laboratory. This talk will pave the way to an accurate diagnosis, after which, effective therapy can be prescribed.

In the United States, over six million children have asthma and over 130,000 children are hospitalized yearly due to asthma exacerbations. Children with difficult-to-treat and/or severe asthma have the highest morbidity and mortality. In addition to ensuring assessment and management per existing guidelines, there is a need for more precise and personalized approaches to asthma management for these patients. This includes identification of phenotypes and tailoring medication choice based on underlying pathophysiology. This talk will address the fundamentals of identifying difficult-to-treat and severe asthma patients and outline steps to create a comprehensive asthma assessment and management plan.

This talk will update listeners on the current DSM-5 guideline-based revisions in diagnostic criteria for eating and feeding disorders. It will cover common presentations for eating disorders in children, adolescents, and young adults as well as practical tips for screening, assessing, and discussing the diagnoses with patients and their families. Participants will walk away with heightened awareness and greater confidence in identifying the possibility or probability of an eating disorder and initiating a proper referral. Because eating disorders are vastly underdiagnosed, it is important to understand that initial presentations may occur in a variety of medical settings, ranging from primary care, to the emergency department, and to the office of the subspecialist.

This lecture will review the most efficient means of assessing cognitive impairment, common issues in caring for the older adult with cognitive impairment, and pharmacologic/ non-pharmacologic means of treating patients. Participants will receive updates on what medications are useless/useful and what testing should be avoided. This lecture will also discuss future options and prognosis for patients with cognitive impairment.

Acute low back pain is a common reason for a patient to visit their primary care provider. Most back symptoms are usually self-limited. History and physical examination typically provide clues to the rare, but potentially serious causes of low back pain. The differential diagnosis will be explored and appropriate use of diagnostic testing, including x-rays, will be discussed. Participants will review current recommendations and treatment algorithms, and learn when it is appropriate to consider specialty referral.

Sudden cardiac death of a young athlete is a rare but devastating event. The pre-participation exam consists of a history and physical, however the sensitivity of this is poor. This talk will review the evaluation recommended by the American Heart Association, the American Academy of Pediatrics, the American Family Physician, as well as the more controversial widespread screening with electrocardiogram and limited focus cardiac ultrasound.

Failure to prescribe anticoagulation to prevent stroke in high-risk atrial fibrillation (AF) patients is a persistent and pervasive problem. Despite a multitude of evidence-based clinical practice guidelines, and five effective oral anticoagulants for stroke prevention, at least 30% of these patients remain unprotected. This talk will focus on understanding the root causes of the failure to prevent stroke crisis. The role of antithrombotic therapy, in particular direct oral anticoagulants, will be reviewed. Strategies for implementation of best practices for stoke prevention in AF will be highlighted.

Improvements in contemporary critical care, including new technology and improvements in life-sustaining treatments, have contributed to a higher rate of survival for patients who face acute, life-threatening critical illnesses. However, patients who survive such a catastrophic event often have long-term consequences of their ICU stay that impact their health and well-being for months or even years. This talk will address best practices for primary care providers in the detection and management of “post-intensive care syndrome” (PICS), the group of health conditions that result from and remain after an ICU stay. PICS can include ICU-acquired weakness and other functional impairments, cognitive dysfunction, depression, anxiety, and post-traumatic stress disorder. In addition, there are significant social and occupational consequences for patients who survive critical illness. Family members of ICU survivors are also at risk for significant long-term health conditions related to their time spent caring for their loved one in the ICU environment and afterwards. We will discuss the current evidence describing PICS and its impact, practical guidance to screen for PICS and its components, and best practices for managing the signs and symptoms of PICS in a primary care clinic. We will also review several common medical complications of critical illness and their typical treatments to identify opportunities to discontinue unnecessary medications during primary care follow-up.

This talk will review how to perform focused physical examinations of the hip and ankle, emphasizing correlation with specific diagnoses. In addition, the session will discuss common problems of the ankle and hip, along with initial treatment strategies.

This lecture will address the appropriate use and potential misuse of antibiotic therapy for the primary care practitioner.